Resources

Addiction

National and local 12 Step programs: There are 12 Step programs available that address many types of addictive behavior, and some have local branches that can help provide addiction treatment or addiction counseling in Tucson.

Anxiety

This long document by the National Institute of Mental Health discusses a wide range of anxiety disorders

Relationships

Communication tips: This article is adapted from a National Institute of Health website, but you can find it here. It is published in an area that is a valid skills-based approach to relationship counseling and relationship communication.

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Communications Tips for Relationships, for Those in Recovery, for Everyone

Communication skills are fundamental to healing in almost every area of life. In relationship counseling, in addiction treatment or therapy, in stress management: clear, respectful communication that is truly two-way is essential.

Copied in below is a set of communication tips designed specifically for cocaine addiction, but these ideas should be useful in many other areas of personal and relationship development as well. This article was published by the National Institute on Drug Abuse of the NIH.

Good Listening Skills

Good listening can help couples communicate more effectively. Although you may feel that listening is easy or natural, it isn’t. Active listening that involves trying to understand your partner is very difficult. It usually takes some training and practice in listening skills.

Before responding, a good listener will try to

• Completely understand what the partner was trying to communicate – what the partner wants and how the partner is feeling.

• Request the feedback and information needed to accurately summarize what the partner intended to say.

Questions you can use to get such feedback are

• Are you saying … ?

• I’m not sure what you mean; can you explain that to me?

• How are you feeling now? Are you mad or upset with me?

• I don’t think I understand your point; can you explain it a little differently?

• Can you give me an example? I’m not sure I understand why you are so upset.

Validation. It is important that you try to validate partners’feelings, that is, let them feel that you think you can understand how and why they feel the way they are feeling. Communicate to them that their feelings make sense. This does not necessarily mean that you agree with them, but that you can understand their point of view. Validating feelings is probably the most important way you can let them know you care about them and the way they feel. It lets partners know that they are important. There are very few other effective ways to convey that message to your partner.

Examples of validating statements are:

• I can understand how you would feel that way, given that …

• No wonder you feel so angry.

• If that’s how you see it, no wonder you are so upset.

Examples of statements that are not validating are –

• That’s silly.

• You shouldn’t feel that way.

• That’s ridiculous.

• I don’t think that should upset you so much.

If you can’t validate your partner’s feelings because you are too upset, take some time to regroup. Suggest a short break in the conversation. Come back when you feel you can validate your partner’s feelings.

Poor Listening

A major cause of poor communication is not listening to your partner. Each partner must seek to understand the other. If you don’t understand a problem, it is very hard to fix it. If you can’t hear and understand your partner’s point of view, the problem will never be resolved effectively.

Poor listening usually sends the following messages:

• I am not interested in your opinions or feelings.

• Your feelings are ridiculous or silly.

• You are foolish to have those feelings.

• Your feelings don’t deserve my attention or concern.

• My opinions and feelings are more important that yours.

• My opinions and feelings are more reasonable than yours.

Obviously, these messages will not resolve a problem. Most likely, they will cause more resentment, bad feelings, and difficulties. Identifying poor listening behavior is not always easy. A few things to look for are –

• Self-summarizing: You or your partner continually restate your position over and over during a discussion or argument.

• Cross-complaining: The complaint of one partner is met with a complaint by the other instead of problemsolving the original complaint. Thus, many old complaints and issues are brought up each time an issue is raised.

• Mind-reading: issues are avoided (at least at first) by partners feeling and acting as if they know the other partner’s feelings and desires. This results in one partner feeling left out of decisionmaking, unimportant, and resentful.

Stop Action or Timeout: Dealing With Poor Communication

The time to act to prevent or effectively deal with conflict is when you recognize that you are getting a response from your partner that you did not intend to get.

If you or your partner realize that miscommunication has occurred, one of you should call a timeout or stop action. You should simply say hold it, timeout, or whatever vou find comfortable. This should signal that it is time to stop the discussion and try to analyze what went wrong.

Once one of you calls a timeout, you should both do the following:

• Find out why your partner is upset or has responded in a particular way.

• Express the message you intended to communicate and specify the response you expected.

• See if you can identify anything like voice tone or bad mood that affected the communication.

• Ask yourselves the following: Are there any hidden agendas? What was I trying to say? Did I say it in an appropriate manner? Was I trying hard to understand my partner? Was I being impolite or just plain stubborn? Did I demonstrate that I cared what my partner was feeling?

Restart the conversation with the intention of listening to your partner. Use good communication skills to express your feelings. Do not blame each other, and try to identify what went wrong the first time in terms of good communication skills. These steps can be used to guide the timeout:

• Call timeout or stop action.

• Listen for feedback from your partner.

• Try to summarize your partner’s viewpoint.

• Try to validate your partner’s feelings.

Patterns of Communication Problems

Once you start identifying the communication problems that exist in your relationship, you will probably notice that you and your partner have developed certain patterns or styles that occur time and time again. just like any other behavior, the way you communicate – good or bad – has become a well-Iearned habit. The first step in changing these problematic communication patterns is to label them so you know what you need to deal with. Four common communication patterns that result in conflict are listed below.

Mind-reading. The ineffective communication behaviors that occur when mind-reading is the problem are –

• You think your partner should know what you want or need without asking.

• If you have to tell your partner what you want, you feel it “doesn’t count.”

• You feel you know what your partner wants or is thinking without being told.

It is unrealistic for you to feel that your partner should know what you want or need. It would be nice if they did, but expecting it is a romantic fantasy. Directly communicating your needs, wants, and feelings is necessary for your partner to learn better to provide you with what you need. Similarly, don’t assume you know what your partner wants; ask your partner so you can more effectively meet your partner’s needs.

Yes, but-ing. If you or your partner have this common communication problem, you will notice that during most arguments or disagreements one or both of you responds to the other’s suggestion or opinion by saying, “Yes, but that won’t work because…… or ‘Yes, but you don’t really understand why I didn’t do it,’ or ‘Yes, but we can’t do that because…” This type of communication sends the message that you don’t want to change or meet your partner’s needs or understand the partner’s point of view. Instead of yes, but-ing, learn to respond by-

• Requesting more information.

• Suggesting a compromise.

• Saying positive things and being more understanding.

Character assassination. Another common communication problem is making change requests or comments that attack your partner’s whole self, rather than specific problem behaviors or areas for change. For example, if you find yourselves making statements like, “Can’t you be more like Jim,” or “Can’t you stop always thinking of yourself,” or “Why do you always have to be so stupid,” then you are engaging in character assassination. This means you are making impossible demands on your partner or inaccurate critical statements. All this usually does is provoke defensive, aggressive, or hurt behavior from your partner. It also does not let your partner know the specific things you would like the partner to do differently. It is important to learn to make specific change requests rather than global, vague assassinations. Also, it is important for the receiver of the assassination to ask the assassin to be more specific and say exactly what is wanted.

The complaining rut. This problematic pattern of communication describes couples who complain all the time without including any suggestions for change or alternatives. If you hear you or your partner saying things like: “Why do you always have to be so mean” or “Can’t you stop coming home late all the time” or “I wish you would stop hanging around with those folks” or “I wish you would spend more time with the kids,” that is a complaining rut. If you make statements like that without including some alternatives or specific requests for change or improvement, then you are in a complaining rut. The problem with this approach is that, when you don’t identify alternatives, all you can do is take note when your partner is engaging in the bad behavior again. If you suggest constructive alternatives, you can then take note of when the partner is making that change and feel good about it.

It is important to learn to only make complaints that include specific statements about what you would like your partner to do instead of the problem behavior. For example, instead of just saying, “I wish you would stop hanging around with those guys,” you could include, “It would be nice if you spent some time each night with the kids helping them with their homework and maybe on Friday nights we could go out to the movies.” Your goal should be to give your partner something specific to try to do so your partner can demonstrate an effort to change.

For more information or to schedule an appointment, please call Janet or Reed at 520-529-1565.

Stress

The article below emphasizes why stress reduction and stress management are so important for our well-being, even our health. It was initially published by the National Institutes of Health in 2000.

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Stress and Disease: New Perspectives

By Harrison Wein, Ph.D.

For thousands of years, people believed that stress made you sick. Up until the nineteenth century, the idea that the passions and emotions were intimately linked to disease held sway, and people were told by their doctors to go to spas or seaside resorts when they were ill. Gradually these ideas lost favor as more concrete causes and cures were found for illness after illness. But in the last decade, scientists like Dr. Esther Sternberg, director of the Integrative Neural Immune Program at NIH’s National Institute of Mental Health (NIMH), have been rediscovering the links between the brain and the immune system.

The Immune System and the Brain

When you have an infection or something else that causes inflammation such as a burn or injury, many different kinds of cells from the immune system stream to the site. Dr. Sternberg likens them to soldiers moving into battle, each kind with its own specialized function. Some are like garbage collectors, ingesting invaders. Some make antibodies, the “bullets” to fight the infectious agents; others kill invaders directly. All these types of immune cells must coordinate their actions, and the way they do that is by sending each other signals in the form of molecules that they make in factories inside the cell.

“It turns out that these molecules have many more effects than just being the walkie-talkie communicators between different kinds of immune cells,” Dr. Sternberg says. “They can also go through the bloodstream to signal the brain or activate nerves nearby that signal the brain.”

These immune molecules, Dr. Sternberg explains, cause the brain to change its functions. “They can induce a whole set of behaviors that we call sickness behavior. . . . You lose the desire or the ability to move, you lose your appetite, you lose interest in sex.” Scientists can only speculate about the purpose of these sickness behaviors, but Dr. Sternberg suggests that they might help us conserve energy when we’re sick so we can better use our energy to fight disease.

These signaling molecules from the immune system can also activate the part of the brain that controls the stress response, the hypothalamus. Through a cascade of hormones released from the pituitary and adrenal glands, the hypothalamus causes blood levels of the hormone cortisol to rise. Cortisol is the major steroid hormone produced by our bodies to help us get through stressful situations. The related compound known as cortisone is widely used as an anti-inflammatory drug in creams to treat rashes and in nasal sprays to treat sinusitis and asthma. But it wasn’t until very recently that scientists realized the brain also uses cortisol to suppress the immune system and tone down inflammation within the body.

Stress and the Immune System

This complete communications cycle from the immune system to the brain and back again allows the immune system to talk to the brain, and the brain to then talk back and shut down the immune response when it’s no longer needed.

“When you think about this cross-talk, this two-way street,” Dr. Sternberg explains, “you can begin to understand the kinds of illnesses that might result if there is either too much or too little communication in either direction.”

According to Dr. Sternberg, if you’re chronically stressed, the part of the brain that controls the stress response is going to be constantly pumping out a lot of stress hormones. The immune cells are being bathed in molecules which are essentially telling them to stop fighting. And so in situations of chronic stress your immune cells are less able to respond to an invader like a bacteria or a virus.

This theory holds up in studies looking at high-levels of shorter term stress or chronic stress: in caregivers like those taking care of relatives with Alzheimer’s, medical students undergoing exam stress, Army Rangers undergoing extremely grueling physical stress, and couples with marital stress. People in these situations, Dr. Sternberg says, show a prolonged healing time, a decreased ability of their immune systems to respond to vaccination, and an increased susceptibility to viral infections like the common cold.

Some Stress is Good

People tend to talk about stress as if it’s all bad. It’s not.

“Some stress is good for you,” Dr. Sternberg says. “I have to get my stress response to a certain optimal level so I can perform in front of an audience when I give a talk.” Otherwise, she may come across as lethargic and listless.

But while some stress is good, too much is not good. “If you’re too stressed, your performance falls off,” Dr. Sternberg says. “The objective should be not to get rid of stress completely because you can’t get rid of stress — stress is life, life is stress. Rather, you need to be able to use your stress response optimally.”

The key is to learn to move yourself to that optimal peak point so that you’re not underperforming but you’re also not so stressed that you’re unable to perform. How much we’re able to do that is the challenge, Dr. Sternberg admits. This may not be possible in all situations, or for all people, because just as with the animals Dr. Sternberg studies, some people may have a more sensitive stress response than others.

“But your goal should be to try to learn to control your stress to make it work for you,” Dr. Sternberg says. “Don’t just think of getting rid of your stress; think of turning it to your advantage.”

Controlling the Immune Response

Problems between the brain and the immune system can go the other way, too. If for some reason you’re unable to make enough of these brain stress hormones, you won’t be able to turn off the immune cells once they’re no longer needed.

“There has to be an exit strategy for these battles that are being fought by the immune system, and the brain provides the exit strategy through stress hormones,” Dr. Sternberg says. “If your brain can’t make enough of these hormones to turn the immune system off when it doesn’t have to be active anymore, then it could go on unchecked and result in autoimmune diseases like rheumatoid arthritis, lupus, or other autoimmune diseases that people recognize as inflammation.”

Dr. Sternberg says that there are several factors involved in these autoimmune conditions. There are many different effects that the brain and its nervous system can have on the immune system, depending on the kinds of nerve chemicals that are being made, where they’re being made, what kind of nerves they come from, and whether they’re in the bloodstream or not. Still, at least part of the problem in these diseases seems to involve the brain’s hormonal stress response.

“So if you have too much stress hormone shutting down the immune response, you can’t fight off infection and you’re more susceptible to infection,” Dr. Sternberg concludes. “Too little stress hormones and the immune response goes on unchecked and you could get an inflammatory disease.”

Pinpointing the Problems

Why these miscommunications between the brain and the immune system come about is still largely unknown, and involves many genes and environmental factors. But by studying animals, scientists have finally been able to start understanding how the miscommunications occur.

Dr. Sternberg first started publishing work on the links between the brain and the immune system back in 1989 studying rats with immune problems. “In many of these cases it’s very hard to show the mechanism in humans,” Dr. Sternberg explains, “but you can show the mechanism in animals because you can manipulate all the different parts of the system and you can begin to understand which parts affect which other parts.” It has taken “a good ten years” to gather enough evidence in human studies to show that the principles her lab uncovered in rats were also relevant to human beings.

Drugs that have been tested in rats to correct brain/immune system problems have had unpredictable effects. That is because nothing happens in isolation when it comes to the brain and the immune system. Dr. Sternberg points out that our bodies are amazing machines which at every moment of the day are constantly responding to a myriad of different kinds of stimuli — chemical, psychological, and physical. “These molecules act in many different ways in different parts of the system,” she says. Understanding how the brain and the immune system work together in these different diseases should help scientists develop new kinds of drugs to treat them that would never have occurred to them before.

Taking Control Now

Dr. Sternberg thinks that one of the most hopeful aspects of this science is that it tells us it’s not all in our genes. A growing number of studies show that, to some degree, you can use your mind to help treat your body. Support groups, stress relief, and meditation may, by altering stress hormone levels, all help the immune system. For example, women in support groups for their breast cancer have longer life spans than women without such psychological support.

There are several components of stress to think about, including its duration, how strong it is, and how long it lasts. Every stress has some effect on the body, and you have to take into account the total additive effect on the body of all stressors when considering how to reduce stress.

Perhaps the most productive way to think about stress is in terms of control. Dr. Sternberg shows a slide of an F-14 jet flying sideways by the deck of an aircraft carrier, its wings completely vertical. “The Navy Commander who flew that jet told me that he was the only one in the photo who was not stressed, and that’s because he was the one in control. The officer sitting in the seat ten feet behind him was in the exact same physical situation but was not in control. Control is a very important part of whether or not we feel stressed.

So if you can learn to feel that you’re in control or actually take control of certain aspects of the situation that you’re in, you can reduce your stress response.” Studies show that gaining a sense of control can help patients cope with their illness, if not help the illness itself.

Until science has more solid answers, it can’t hurt to participate in support groups and seek ways to relieve stress, Dr. Sternberg says. But what you need to remember is if you do these things and you’re not successful in correcting whatever the underlying problem is, it’s not your fault because there’s a biology to the system. “You need to know the benefits of the system,” she says, “but its limitations as well.” In other words, try not to get too stressed about being stressed. — a report from The NIH Word on Health, October 2000

For more information about this story, contact: Harrison Wein, Ph.D. Writer and Editor NIH Office of Communications and Public Liaison Phone: 301-435-7489 Fax: 301-402-1485 E-mail: weinh@od.nih.gov

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Addiction

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Introducing… Your Brain!

Anxiety

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Anxiety Disorder Overview

Relationships

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Communications Tips for Relationships, for Those in Recovery, for Everyone

Poor Listening

Stop Action or Timeout: Dealing With Poor Communication

Patterns of Communication Problems

Stress

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